Predictors Of Incomplete Evaluation Among Pediatric Household Contacts Of Pulmonary Tuberculosis Patients In Kampala, Uganda: A Secondary Analysis
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Abstract
Background: Contact investigation is an active approach to identifying new TB cases by screening contacts of known patients for symptoms and risk factors. This is particularly important for child contacts of TB patients because young children are at higher risk of progressing to severe disease compared to adults. Moreover, children are unable or unlikely to travel to clinics for evaluation independently, so their access to TB evaluation may depend on the adults in their household.
Objective: To evaluate the association between individual- and household-level characteristics and completion of TB evaluation for children under 15 years.
Setting: Seven public tuberculosis (TB) units in Kampala, Uganda.
Design: A prospective cohort study nested into a household-randomized, controlled, pragmatic parent trial. Participants were recruited from both the intervention and control arm. Completion of TB evaluation was defined as a child going to the clinic after being referred during household contact investigation. We used generalized estimating equations with logistic regression to estimate the association between completion of TB evaluation among children and individual- and household-level characteristics.
Results: Of 196 contacts under 5 years who were referred for evaluation, only 25 (13%) completed evaluation for TB by day 60. Of 48 contacts 5-14 years who were referred for TB evaluation, only 19 (40%) completed by day 60. In children under 5, controlling for age and household head’s level of education, presence of TB symptoms (adjusted risk ratios (aRR) 2.6, 95%CI 1.14-6.01, P=0.024) and household income (aRR 1.2, 95%CI 1.11-1.36, P=<0.001) were significantly associated with completion of TB evaluation on day 60.
Conclusion: The majority of children who are referred for TB evaluation do not reach a clinic within 60 days. Children in higher-income households and children with symptoms that are evident to their parents and are more likely to complete TB evaluation than children in lower-income households or those without recognized symptoms. Further research is needed to identify barriers to pediatric evaluation among low-income households, strategies for motivating the parents of asymptomatic children, and interventions that will increase completion of pediatric TB evaluation.